Diagnóstico citológico de ASCUS. Identificación del riesgo para displasia cervical mediante test del virus del papiloma humano

Abstract

Objective To identify women with cervical neoplasia amongst those patients diagnosed as having ASCUS after colposcopy and comparing the PCR study for human papilloma virus (HPV) with a repeat cervico-vaginal histology. Also, to determine if PCR for HPV is useful in patients diagnosed as ASCUS, and if it may be an alternative to repeat cervical cytology. Material and methods A study was made of 180 women, after colposcopy, repeat cytology, PCR for HPV, and a histological study of the cervical biopsies. Results PCR was positive in 34% of the patients and negative in the other 66%. No cervical lesion was found in 69%, there was condilloma or CIN I in 21% and CIN II or CIN III in 10%. Applying Bayes theorem, sensibility for PCR was 60%, specificity was 80%, VPP 61% and VPN 79%; for cytology, the sensibility was 64%, specificity 88%, VPP 71% and VPN 84%, including as positive those smear test repeatedly diagnosed as ASCUS. Conclusions In our study, repeat cytology and PCR testing for HPV had similar sensibility, specificity, VPP and VPN values, the confidence intervals were also similar. We highlight the 94% negative predictive value for PCR, this being the most appropriate method to identify those women who are not going to develop disease.